Article

Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with ADHD

Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114.
American Journal of Psychiatry (Impact Factor: 13.56). 01/1994; 150(12):1792-8.
Source: PubMed

ABSTRACT Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings.
Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied. Findings were compared with those from a preexisting study group of referred children with attention deficit hyperactivity disorder, nonreferred adult relatives of those children who also had attention deficit hyperactivity disorder, and adults without the disorder who were relatives of normal children. Subjects were evaluated with a comprehensive battery of psychiatric, cognitive, and psychosocial assessments.
The referred and nonreferred adults with attention deficit hyperactivity disorder were similar to one another but more disturbed and impaired than the comparison subjects without the disorder. The pattern of psychopathology, cognition, and functioning among the adults with attention deficit hyperactivity disorder approximated the findings for children with the disorder.
These results show that referred and nonreferred adults with attention deficit hyperactivity disorder have a pattern of demographic, psychosocial, psychiatric, and cognitive features that mirrors well-documented findings among children with the disorder. These findings further support the validity of the diagnosis for adults.

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    • "While the aADHD group presented with elevated rates for the entire Cluster B compared with a representative control sample in the NESARC, the most frequent comorbid PD in was borderline PD with 33.7%, followed by narcissistic PD with 25.2%, schizotypal PD with 22.4%, and antisocial PD with 18.9% (Bernardi et al., 2011). Interestingly, prospective (Fischer, Barkley, Smallish, & Fletcher, 2002; Mannuzza, Klein, Bessler, Malloy, & LaPadula, 1993, 1998; Rasmussen & Gillberg, 2001; Weiss, Hechtman, Milroy, & Perlman, 1985) and the majority of cross-sectional studies (Biederman, Faraone, Monuteaux, Bober, & Cadogen, 2004; Biederman et al., 1993; Sobanski, 2006) furthermore found the ubiquitously reported elevated rates of conduct and oppositional defiant disorder in childhood and adolescence to be connected to findings of an increased risk for antisocial PD in adulthood. "
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    ABSTRACT: Objective: Despite growing awareness of adult ADHD and its comorbidity with personality disorders (PDs), little is known about sex- and subtype-related differences. Method: In all, 910 patients (452 females, 458 males) affected with persistent adult ADHD were assessed for comorbid PDs with the Structured Clinical Interview of DSM-IV and for personality traits with the revised NEO personality inventory, and the Tridimensional Personality Questionnaire. Results: The most prevalent PDs were narcissistic PD in males and histrionic PD in females. Affected females showed higher Neuroticism, Openness to Experience, and Agreeableness scores as well as Harm Avoidance and Reward Dependence scores. Narcissistic PD and antisocial PD have the highest prevalence in the H-type, while Borderline PD is more frequent in the C-type. Conclusion: Sex- and subtype-related differences in Axis II disorder comorbidity as well as impairment-modifying personality traits have to be taken into account in epidemiological studies of persistent ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX).
    Journal of Attention Disorders 02/2014; DOI:10.1177/1087054714521293 · 2.40 Impact Factor
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    • "The main aim of the CAT study was to assess the frequency and type of psychiatric comorbidities observed in adults receiving a de novo diagnosis of ADHD. The percentage observed (66.2%) indicates a high proportion of concomitant psychiatric conditions, in line with the majority of data available in the literature (Biederman et al., 1993; Biederman, Newcorn, & Sprich, 1991; Kessler et al., 2006; Kooij et al., 2010; Sobanski et al., 2007) although lower than that observed in other studies (McGough et al., 2005). The types of comorbidities observed, led by SUDs (39.2%) and followed by anxiety disorders (23%), mood disorders (18.1%), and personality disorders (14.2%), also converges with previous findings (Barkley & Brown, 2008). "
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    ABSTRACT: Objective: The CAT (Comorbilidad en Adultos con TDAH) study aimed to quantify and characterize the psychiatric comorbidity at the time of diagnosis of ADHD in adult outpatients. Method: Cross-sectional, multicenter, observational register of adults with ADHD diagnosed for the first time. Results: In this large sample of adult ADHD (n = 367), psychiatric comorbidities were present in 66.2% of the sample, and were more prevalent in males and in the hyperactive-impulsive and combined subtypes. The most common comorbidities were substance use disorders (39.2%), anxiety disorders (23%), and mood disorders (18.1%). In all, 88.8% patients were prescribed pharmacological treatment for ADHD (in 93.4% of cases, modified release methylphenidate capsules 50:50). Conclusion: A high proportion of psychiatric comorbidity was observed when adult outpatients received a first-time diagnosis of ADHD. The systematic registering of patients and comorbidities in clinical practice may help to better understand and manage the prognostic determinants in adult ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX).
    Journal of Attention Disorders 01/2014; DOI:10.1177/1087054713518240 · 2.40 Impact Factor
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    • "Psychiatric co-morbidity is common in adults with ADHD [8,15,33-35], as well as in adults with SUD without ADHD [36-39]. In the current study, psychiatric symptoms were common in both the ADHD/SUD group and the general SUD group and the findings indicate that externalizing and antisocial behaviour, rather than psychiatric symptoms, are more distinctive for the ADHD/SUD group than for the general SUD group. "
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    ABSTRACT: Attention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse. The Swedish legislation on compulsory healthcare can be applied to persons with severe substance abuse who can be treated involuntarily during a period of six months. This context enables a reliable clinical assessment of ADHD in individuals with severe substance use disorder (SUD). In the context of compulsory care for individuals with severe SUD, male patients were assessed for ADHD, co-morbid psychiatric symptoms, psychosocial background, treatment history, and cognition. The data from the ADHD/SUD group (n = 60) was compared with data from (1) a group of individuals with severe substance abuse without known ADHD (SUD group, n = 120), as well as (2) a group with ADHD from an outpatient psychiatric clinic (ADHD/Psych group, n = 107). Compared to the general SUD group in compulsory care, the ADHD/SUD group had already been significantly more often in compulsory care during childhood or adolescence, as well as imprisoned more often as adults. The most common preferred abused substance in the ADHD/SUD group was stimulant drugs, while alcohol and benzodiazepine abuse was more usual in the general SUD group. Compared to the ADHD/Psych group, the ADHD/SUD group reported more ADHD symptoms during childhood and performed poorer on all tests of general intellectual ability and executive functions. The clinical characteristics of the ADHD/SUD group differed from those of both the SUD group and the ADHD/Psych group in several respects, indicating that ADHD in combination with SUD is a particularly disabling condition. The combination of severe substance abuse, poor general cognitive ability, severe psychosocial problems, including indications of antisocial behaviour, and other co-existing psychiatric conditions should be considered in treatment planning for adults with ADHD and SUD.
    BMC Psychiatry 12/2013; 13(1):336. DOI:10.1186/1471-244X-13-336 · 2.24 Impact Factor
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